What Is Surgery - Multinodular Goiter
Multinodular Goiter
Multinodular goiter is common in middle age women. Multinodular goiter is presented as multiple nodules in an enlarged thyroid gland.
Clinical stuff
On examination. Observe the patient with any signs of hypothyroidism or hyperthyroidism. We need to inspect for any thyroidectomy scar which is often present below the necklace.
Patient may present with raised jugular venous pressure with dilated vein. Swallow test is considered by asking the patient to swallow water and observe for the movement of goiter or thyroglossal cyst while swallowing. Only thyroglossal cyst will moved if the patient is asked to stick the tongue out.
We need to record the shapes mobility, sizes and shapes of the mass ( multinodular goiter) The cervical lymph nodes is palpated while the tracheal deviation need to be felt. Goiter may present with vascular thrill.
Patient may suffer from atrial fibrillation in this cases ( hyperthyroid patient). Dullness on percussion over the manubrosternum is an indication of the retrosternal goiter. Thyroid bruit may be heard on auscultation due to increase in the blood flow locally.
How to investigate this problems?
Thyroid function test is considered as well as autoantibody screen.
Chest X ray is considered in cases of compression of the trachea from the retrosternal goiter. Other imaging technique may include CT scan and MRI scan as well as Tc 99m or I 123 radionuclide imaging to detect hyperfunctioning and hypofunctioning nodules.
Fine needle aspiration under ultrasound guidance is also considered.
Complications of multinodular goiter ?
The complications of multinodular goiter may include rupture of the noludar goiters, hemorrhagic multinodular goiter and 5 percent risk of developing thyroid cancer.
Multinodular goiter may also effect the function of thyroid hormone and may lead to hyperthyroidism and hypothyroidism.
The large multinodular goiter may also lead to mass effect such as superior vena cava obstruction, compression of the esophagus and compression as well as deviation of the trachea.
The treatment of multinodular goiter ?
The treatment may include thyroxine given to patient with no abnormalities in the blood thyroid hormone level.
Radioiodine is given in case the patient is euthyroid or suffer from thyrotoxicosis. Tetracycline is considered in cases of cystic multinodular goiter.
The surgical treatment may focus on total removal of the thyroid gland / total thyroidectomy. In this case the patient may required long term thyroid replacement therapy. The common complications of total thyroidectomy may include hypoparathyroidism, infection, recurrent laryngeal nerve injury, superior laryngeal nerve injury and temporary hypocalcemia.
Multinodular goiter is common in middle age women. Multinodular goiter is presented as multiple nodules in an enlarged thyroid gland.
Clinical stuff
On examination. Observe the patient with any signs of hypothyroidism or hyperthyroidism. We need to inspect for any thyroidectomy scar which is often present below the necklace.
Patient may present with raised jugular venous pressure with dilated vein. Swallow test is considered by asking the patient to swallow water and observe for the movement of goiter or thyroglossal cyst while swallowing. Only thyroglossal cyst will moved if the patient is asked to stick the tongue out.
We need to record the shapes mobility, sizes and shapes of the mass ( multinodular goiter) The cervical lymph nodes is palpated while the tracheal deviation need to be felt. Goiter may present with vascular thrill.
Patient may suffer from atrial fibrillation in this cases ( hyperthyroid patient). Dullness on percussion over the manubrosternum is an indication of the retrosternal goiter. Thyroid bruit may be heard on auscultation due to increase in the blood flow locally.
How to investigate this problems?
Thyroid function test is considered as well as autoantibody screen.
Chest X ray is considered in cases of compression of the trachea from the retrosternal goiter. Other imaging technique may include CT scan and MRI scan as well as Tc 99m or I 123 radionuclide imaging to detect hyperfunctioning and hypofunctioning nodules.
Fine needle aspiration under ultrasound guidance is also considered.
Complications of multinodular goiter ?
The complications of multinodular goiter may include rupture of the noludar goiters, hemorrhagic multinodular goiter and 5 percent risk of developing thyroid cancer.
Multinodular goiter may also effect the function of thyroid hormone and may lead to hyperthyroidism and hypothyroidism.
The large multinodular goiter may also lead to mass effect such as superior vena cava obstruction, compression of the esophagus and compression as well as deviation of the trachea.
The treatment of multinodular goiter ?
The treatment may include thyroxine given to patient with no abnormalities in the blood thyroid hormone level.
Radioiodine is given in case the patient is euthyroid or suffer from thyrotoxicosis. Tetracycline is considered in cases of cystic multinodular goiter.
The surgical treatment may focus on total removal of the thyroid gland / total thyroidectomy. In this case the patient may required long term thyroid replacement therapy. The common complications of total thyroidectomy may include hypoparathyroidism, infection, recurrent laryngeal nerve injury, superior laryngeal nerve injury and temporary hypocalcemia.
